title: Steroid metabolism and excretion in severe anorexia nervosa: effects of refeeding.
abstract: BACKGROUND
  To our knowledge, changes in steroid metabolism in subjects with anorexia nervosa (AN) after weight gain have not been elucidated.
  
  
  OBJECTIVE
  We characterized urinary steroid excretion and metabolism in AN patients and investigated the effects of refeeding.
  
  
  METHODS
  In an intervention study, we recruited 7 women with life-threatening weight loss upon admission and after a median [interquartile range (IQR)] of 95 d (88-125 d) of intensive refeeding; 15 age-matched women were recruited as control subjects. The major urinary metabolites were quantified in 24-h collections by capillary gas chromatography. A single examiner measured weights, heights, and skinfold thicknesses.
  
  
  RESULTS
  The median (IQR) age of patients was 24 y (21-26 y), and the duration of AN was 4.0 y (3.3-8.0 y). Body mass index (BMI; in kg/m(2)) increased from 12.8 (12.7-13.1) to 18.6 (18.0-19.6) after refeeding (P < 0.0001). Steroid values [median pre-, post-refeeding (P value)] were as follows: androgen metabolites [472, 1017 μg/24 h (0.93)], cortisol metabolites [1960, 3912 μg/24 h (0.60)], and ratios of androsterone (5α)/etiocholanolone (5β) [0.28, 0.63 (<0.001)], 5α-/5β-tetrahydrocortisol [0.20, 0.48 (0.02)], tetrahydrocortisols/tetrahydrocortisone [0.87, 0.61 (0.09)], 20-hydroxy-/20-oxocortisol metabolites [0.29, 0.47 (0.01)], and 20α-/20β-reduced cortisol metabolites [1.18, 1.89 (≥1.00)]. BMI change was positively correlated with 5α-/5β-tetrahydrocortisol (r = 0.95, P < 0.001). Before refeeding, the following metabolites were lower in patients than in control subjects: androsterone, 5α-tetrahydrocortisol, α-cortolone and α-cortol, 5α-/5β-tetrahydrocortisol, androsterone/etiocholanolone, and 20-hydroxy/20-oxocortisol (all P < 0.05). After refeeding, all steroid metabolites in patients were at concentrations that were comparable with those in control subjects.
  
  
  CONCLUSIONS
  Significant changes in urine steroid-metabolite excretion occurred upon starvation, which were reversed upon refeeding. For cortisol, there were decreases in 5α-/5β-tetrahydrocortisol and 20-hydroxy-/20-oxometabolites; for androgen, there was a decrease in androsterone/etiocholanolone.
authors.affiliation: Department of Clinical Biochemistry, King's College Hospital National Health Service Foundation Trust, London, United Kingdom. ws.wassif@bedfordhospital.nhs.uk
authors.forename: Wassif S
authors.initials: WS
authors.lastname: Wassif
authors.forename: Declan M
authors.initials: DM
authors.lastname: McLoughlin
authors.forename: Royce P
authors.initials: RP
authors.lastname: Vincent
authors.forename: Simon
authors.initials: S
authors.lastname: Conroy
authors.forename: Gerald F M
authors.initials: GF
authors.lastname: Russell
authors.forename: Norman F
authors.initials: NF
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000465:Algorithms; D000728:Androgens / Q000378:metabolism* / Q000652:urine*; D000738:Androsterone / Q000652:urine; D000856:Anorexia Nervosa / Q000178:diet therapy* / Q000378:metabolism / Q000652:urine*; D015992:Body Mass Index; D004032:Diet; D005043:Etiocholanolone / Q000652:urine; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000031:analogs & derivatives / Q000378:metabolism* / Q000652:urine*; D007536:Isomerism; D013760:Tetrahydrocortisol / Q000652:urine; D055815:Young Adult
chemical_list: D000728:Androgens; C016499:20-hydroxycortisol; D013760:Tetrahydrocortisol; D005043:Etiocholanolone; D000738:Androsterone; D006854:Hydrocortisone